Bladder and dementia therapy may be incompatible

By David Douglas
05 june 2008--In a study of elderly nursing home patients, those who took medications for dementia called cholinesterase inhibitors and medications for incontinence called anticholinergics at the same time had a 50 percent faster decline in function than those who were being treated only for dementia.
"Over a year's time, the decline would represent a resident going from requiring only limited assistance in an activity to being completely dependent, or from requiring only supervision to requiring extensive assistance in an activity," study chief Dr. Kaycee M. Sink, of Wake Forest University, Winston-Salem, North Carolina said in a university-issued statement.
These two drug classes "cancel each other out should not be used in combination," Sink added in comments to Reuters Health.
The researchers report the finding in the Journal of the American Geriatrics Society.
Sink and colleagues studied data on more than 3,500 elderly nursing home residents who were taking cholinesterase inhibitors, drugs that increase levels of acetylcholine, a chemical that enhances communication between nerve cells in the brain. Examples of cholinesterase inhibitors include donepezil (Aricept), galantamine (Razadyne), rivastigmine (Exelon), and tacrine (Cognex).
About 10 percent of the residents were also taking either oxybutynin (Ditropan) or tolterodine (Detrol), the two most often prescribed drugs for urinary incontinence. These drugs are known as anticholinergics and are designed to block acetylcholine.
According to the researchers, the combination of drugs affected older adults who started out with higher levels of function in routine activities of daily living such as dressing, personal hygiene, going to the bathroom, getting out of bed, eating and being able to get around the nursing home.
Specifically, they found that, in people who initially were most capable of performing routine activities of daily living and were not taking the bladder drug, functioning declined by an average of 1.08 points per quarter, while in those who were taking both types of drugs, the decline in functioning was 1.62 points per quarter -- a significant 50 percent greater decrease.
In patients who started out with lower functional ability, there was no excess decline attributable to dual therapy. There also were no between-group differences overall in cognitive function in patients taking or not taking both types of drugs.
Sink thinks it is "important for physicians and patients to work together to decide which symptom they would rather treat with a medication: the dementia -- Alzheimer's -- or the overactive bladder."
"If it is the dementia," he concluded, "then the overactive bladder symptoms can be managed by non-medication approaches."
SOURCE: Journal of the American Journal of Geriatrics, May 2008.